Medicaid Expansion Resolving Slowly As State Legislative Sessions Wind Down

As the regular sessions of many state legislatures come to an end, a few states have resolved the question whether to expand Medicaid, while others continue the debate. North Dakota sent expansion legislation to the governor on April 10, 2013. Arizona is poised to pass the expansion as urged by Republican Governor Jan Brewer. Idaho passed H248, establishing a health insurance exchange, and S1100, which provides that a health care sharing ministry is not considered to be engaged in the business of insurance for purposes of the Insurance Code. But it adjourned without passing legislation to expand Medicaid.

In Iowa, Democrats in the legislature and Republican Governor Terry Branstad have presented competing proposals—and, perhaps, competing realities. But they’re looking for common ground.

Premium Assistance for Private Insurance

The Arkansas expansion waiver has interested officials in other states that previously were hostile to expansion. The Arkansas House passed enabling legislation on April 11, 2013. CMS recently expressed its openness to approving premium assistance programs, which use state funds to help the newly eligible purchase private insurance, and, in particular, demonstration projects to provide premium assistance for the purchase of qualified health plans (QHPs) on the health insurance exchanges. The agency would require that: (1) beneficiaries have at least two qualified health plans to choose from; (2) states arrange for “wraparound coverage” to cover any benefits or cost sharing not included in the QHP packages; (3) the demonstrations end December 31, 2016, when they could be replaced by demonstrations under the state innovation waiver authority that becomes effective January 1, 2017.

Republican leaders in the Ohio House of Representatives deleted the Medicaid expansion from the state’s budget, even though it was a market-based program modeled after Arkansas’ and backed by Republican Governor John Kasich. But Kasich says he won’t give up. On Thursday, September 11, 2013, thousands of people rallied at the state capital, where a speaker from the Cincinnati Regional Chamber of Commerce told them that failure to expand could cost Ohio businesses $88 million.

Unintended Consequences of the President’s Proposed Budget

The proposed budget released on Tuesday, April 9, delayed for one year the cuts to Medicaid allotments for state payments to disproportionate share hospitals (DSH). Now, Republicans in Missouri call the delay a gift because it eliminated one of the arguments for expansion. In Mississippi, Republican House leader Philip Gunn argued that the development reflected the uncertainty of federal funding. Republican Governor Phil Bryant was glad that the budgets of states that did not adopt Medicaid expansion were not adversely affected and the state had “time to make a reasonable decision.” The state legislature adjourned without passing any Medicaid budget at all. A special session will be necessary to reauthorize the program for the next fiscal year, which begins July 1st.

Down, But Perhaps, Not Out

Michigan‘s Governor Rick Snyder has not yet persuaded either house of the legislature, both controlled by his party, to back his plans for expansion. On September 11, 2013, the Senate Budget Committee voted down his proposal. But at least some Michigan Republicans would be open to a waiver of some kind.

In Florida, the Republican-controlled House has released a plan, to be funded solely with state dollars, which would cover the parents of minor children and individuals with disabilities with incomes up to 100 percent of the federal poverty level. Health News Florida reports that much of the 47-page document argues against Medicaid expansion because most uninsured people aren’t poor, people who lose insurance pick it up again within a year, and people who are poor don’t stay poor for long. It would cover about 115,000 people, where the Senate plan would add about 1 million people to the Medicaid rolls.